Good information to know about prednisone.

"PMR starts because your body is not producing enough cortisol."
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My understanding is cortisol levels are "normal" or "above normal" when PMR starts. However the body isn't producing enough cortisol under the circumstances that are present at the onset of PMR. Keep in mind that cortisol is the "stress hormone" and the production of cortisol needs to increase significantly during stressful times. While a person's cortisol level might be adequate for normal average circumstances, it is inadequate for more stressful situations. People say stress is the trigger for PMR.

https://academic.oup.com/rheumatology/article/39/6/624/1783929
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The body screams for "more cortisol." The way the body lets us know about a cortisol shortfall is how PMR feels. This might be a short term shortfall of cortisol and people are able to taper off Prednisone quickly.

The autoimmune part is different in my opinion. The way it was explained to me for "reactive arthritis" is that it is triggered by an infection. The infection I had at the start was severe so my need for cortisol increased significantly.

Whether it is an infection or some other trigger it is called an "antigen." An antigen can be almost anything. An antigen may be a substance from the environment, such as chemicals, bacteria, viruses, or pollen. An antigen may also form inside the body.

Regardless of the antigen it is something the immune system will attack. Many times these antigens are "chemically similar" to the body's own tissues. The immune system "misidentifies' our tissues and mistakes them for the antigen. Since our own tissues will always remain, the immune system will eventually develop a memory for attacking our own tissues. This sets the stage for "chronic inflammation" and an autoimmune disorder.

Initially I think the body uses both the endogenous cortisol from the adrenals and the synthetic exogenous form of cortisol that prednisone supplies. As inflammation subsides the need for cortisol subsides. Decreasing the cortisol level should be done by the mechanism called the HPA axis. However, we are told to take excess prednisone instead of allowing the HPA axis to reduce our cortisol level naturally.

The body tries to compensate for having too much exogenous synthetic cortisol by shutting down the endogenous cortisol from the adrenal glands. This sets the stage for adrenal insufficiency if we take prednisone too long.

All is well except for Prednisone side effects from too much Prednisone until we taper our prednisone dose lower. Somewhere in single digits of prednisone, we have a cortisol shortfall again. We take more Prednisone and the cycle continues until our adrenals resume cortisol production again. The adrenals won't resume cortisol production as long as we are taking more Prednisone than the body needs. However, if we don't take enough Prednisone, the body will scream for more.

"PMR starts because your body is not producing enough cortisol."
--------------------------------------------------
My understanding is cortisol levels are "normal" or "above normal" when PMR starts. However the body isn't producing enough cortisol under the circumstances that are present at the onset of PMR. Keep in mind that cortisol is the "stress hormone" and the production of cortisol needs to increase significantly during stressful times. While a person's cortisol level might be adequate for normal average circumstances, it is inadequate for more stressful situations. People say stress is the trigger for PMR.

https://academic.oup.com/rheumatology/article/39/6/624/1783929
-----------------------------------------------------
The body screams for "more cortisol." The way the body lets us know about a cortisol shortfall is how PMR feels. This might be a short term shortfall of cortisol and people are able to taper off Prednisone quickly.

The autoimmune part is different in my opinion. The way it was explained to me for "reactive arthritis" is that it is triggered by an infection. The infection I had at the start was severe so my need for cortisol increased significantly.

Whether it is an infection or some other trigger it is called an "antigen." An antigen can be almost anything. An antigen may be a substance from the environment, such as chemicals, bacteria, viruses, or pollen. An antigen may also form inside the body.

Regardless of the antigen it is something the immune system will attack. Many times these antigens are "chemically similar" to the body's own tissues. The immune system "misidentifies' our tissues and mistakes them for the antigen. Since our own tissues will always remain, the immune system will eventually develop a memory for attacking our own tissues. This sets the stage for "chronic inflammation" and an autoimmune disorder.

Initially I think the body uses both the endogenous cortisol from the adrenals and the synthetic exogenous form of cortisol that prednisone supplies. As inflammation subsides the need for cortisol subsides. Decreasing the cortisol level should be done by the mechanism called the HPA axis. However, we are told to take excess prednisone instead of allowing the HPA axis to reduce our cortisol level naturally.

The body tries to compensate for having too much exogenous synthetic cortisol by shutting down the endogenous cortisol from the adrenal glands. This sets the stage for adrenal insufficiency if we take prednisone too long.

All is well except for Prednisone side effects from too much Prednisone until we taper our prednisone dose lower. Somewhere in single digits of prednisone, we have a cortisol shortfall again. We take more Prednisone and the cycle continues until our adrenals resume cortisol production again. The adrenals won't resume cortisol production as long as we are taking more Prednisone than the body needs. However, if we don't take enough Prednisone, the body will scream for more.

Thank you for sharing. This all makes sense to me. Why is it that doctors are so focused on “prednisone only” to relieve the symptoms of inflammation. Why do they not get to the root of trying to adjust the cortisol levels in the adrenal gland.? Also anti-inflammatory diets and physical therapy stretch exercises can help.

Hi Dadcue, thanks for the link regarding prednisone.
I too have that “love/hate relationship with prednisone. Short term it has saved me through many health crises over the last 60 years or so.
Long term it has left me with Osteoporosis that has left me vulnerable to fractures ( two in the last five years!). I do have to take a yearly infusion of Reclast for my bones and calcium/magnesium supplements.
I have been off and on prednisone on a short term basis the last 60 years or so. But with PMR I have had a more long term experience. Currently I’m on my second run with PMR.
Prednisone has always initially given me insomnia and lots of energy at first. This time around it is the fatigue that really bothers me—and I noticed I’m a lot more grumpy with my hubby and my daughter—-but I think that also is pain related. I’m down to 7.5 mg and my doctor really wants me off of it .
I’m also diabetic and an asthmatic who is prone to respiratory infections. So he is trying to get me on Actemra and I really hope this will get me off prednisone!

Patients like prednisone for PMR. It works rapidly and that is what patients know and care about the most. There are also people who think doctors are idiots for not treating PMR correctly because they don't prescribe enough prednisone.

It is a tough decision for doctors to make. They don't enjoy their patients being in pain. However, they are reluctant to prescribe liberal doses of prednisone on a long term basis because they are fearful of the long term side effects.

I don't know the answer to this dilemma. Until something else works medically as well as prednisone, that is what we are stuck with.

I had a love/hate relationship with prednisone. I knew Prednisone wasn't good for me but I didn't think there were any alternatives to prednisone. I'm just happy my rhematologist was willing to try something that wasn't prednisone. The other part was my willingness to try the alternative.

Have you seen the cartoon about the running faucet with the sink overflowing?? The doctors are mopping up the mess without turning off the faucet. The carton wasn't about chronic inflammation but it seems pertinent to PMR.

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